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. 2025 May 14;8(1):42.
doi: 10.1186/s42155-025-00561-y.

Learning curve in the endovascular treatment of chronic post-thrombotic syndrome in a French center

Paul Segui  1 , Valérie Monnin-Barès  2 , Monira Nou  2   3 , Sébastien Bommart  2 , Hamid Zarqane  2 , Juliette Vanoverschelde  2 , Hélène Vernhet-Kovacsik  2
Affiliations

Learning curve in the endovascular treatment of chronic post-thrombotic syndrome in a French center

Paul Segui et al. CVIR Endovasc. .

Abstract

Purpose: Chronic post-thrombotic syndrome (PTS) is a frequent and disabling complication of deep vein thrombosis (DVT) with significant clinical impact. Endovascular stenting (EVS) has established itself as an effective technique but its availability remains limited to expert centers. We sought to identify the key determinants of our learning curve in EVS for PTS and the impact of this experience on our short and long-term results, in order to facilitate territorial dissemination and respond effectively to clinical demand.

Material and methods: We reviewed the records of 68 patients treated in our centre during eight years. We collected patients and disease characteristics, technical elements of the procedure, peri-procedural medical management and detail of the clinical follow-up and imaging.

Results: The median follow-up was 37 months. The primary, primary assisted and secondary patency rates were respectively 74%, 86% and 95%. A clinical benefit was observed in all patients from the start of our activity, without significant change whatever the operator experience. The main determinants of our learning curve were a progressive mastery of the procedure in its technicality and preparation, the evolution of the material and the improvement of the peri procedural management, allowing to reduce the duration of intervention, the rate of endovascular revision (38% to 4%, p < 0.01) but also the number of remote thrombotic events (29% to 6%).

Conclusion: EVS appears to be an effective therapeutic option in the management of PTS, with consistent clinical improvement observed even when performed by less experienced operators. Improvement in this technique comes with faster procedures, and a reduction of the occurrence of peri-procedural and long term thrombotic events. The implementation of this type of procedure requires multi-disciplinary collaboration with vascular medicine and corresponding angiologists.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: No consent was needed for this retrospective study. Consent for publication: Not applicable. Competing interests: None.

Figures

Fig. 1
Fig. 1
Number of interventions needed to achieve permeability during index hospitalization over time
Fig. 2
Fig. 2
Dose Area Product reduction over time
Fig. 3
Fig. 3
Clinical scores improvement over time
Fig. 4
Fig. 4
Example of measurements used to chose stenting size and level in EVS procedure
Fig. 5
Fig. 5
Phlebograms of the same patient at the time of surgery. A Initial stenting too short, with phlebography showing disappearance of collaterals, but flow remaining slowed. B After comparison with phleboscanner, extension of stenting opposite bone landmarks decided upstream (arrow). C Final control phlebography showing rapid washout with disappearance of collaterals
See this image and copyright information in PMC

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